The future is not about developing but reducing the need for liver transplant: Prof Dr. Mohamed Rela

Prof. Dr. Mohamed Rela, Director - Institute of Liver Disease & Transplantation, Global Hospitals Group, has been recognized by ‘Top Masters in Healthcare Administration’ as one of the 20 Most Innovative Pediatric Surgeons Alive Today in the world.

A fellow of the Royal College of Surgeons, Prof. Rela is also the Chair of the Pediatric Committee for the International Liver Transplantation Society. He has performed more than liver 3,000 transplants, including one on a five-day-old baby, earning him an entry into the Guinness Book of Records. He is known in India and around the world for successfully performing highly complex surgeries to save the lives of very young children.

Prof Dr. Mohamed Rela talks to ETHealthworld about the liver transplant scenario in India and the challenges associated with it. Edited excerpts:

How has liver transplantation evolved over years?

India has a large burden of liver diseases. It is one among the countries where there is high proportion of liver disease particularly related to hepatitis B and hepatitis C viruses. India has also got a large burden of fatty liver diseases but in terms of treatment in the form of liver transplantation, India has taken a long time for it to be successful.

In the last ten years liver transplantation has become a reality and now large number of liver transplants in the form of living donor transplantation is taking place in India.

How do you compare liver transplants in India and those in the West?

In terms of the requirement for liver transplantation, we are still behind. We do around 1400 liver transplants in India. The requirement for liver transplantation is probably in the range of 10 – 15 per million populations. We need to do 10 times more liver transplantation if you look at the necessity for the population. We are far behind in terms of living donor transplantation, deceased donor or cadaver liver transplantation. If you look at the number of transplants done in this country, more than a 1000 of these are living donor transplantation.

In the whole of the United States there are probably only around 250 living donor liver transplants. We probably do four times more than United States, ten times more than what is done in Europe and we are doing as much living donor transplantation as in the eastern countries like Korea and Japan.

We are really racing ahead in the competition for the technicalities of living donor liver transplant. We are better than the Western countries and hopefully we will overtake everybody else other than China who might overtake us.

Tell us about the latest technical advances in liver transplantation.

The latest technical advance in liver transplantation comes from living donor liver transplant. In the Western world most of the advancements are in terms of split liver transplants, sharing organs, preserving organs, use of marginal organs and increasing access for the population for liver transplant. All of that is disease donor liver transplant - whereas in the East all the high-tech developments have come from living donor liver transplants and India is in the forefront for those developments.

What are the common challenges faced by people needing a liver transplantation?

The challenges are about access for the population. Large proportion of the population can’t afford this treatment. The cost of liver transplantation is well over 20 lakhs and unless the government undertakes to fund, it will not be accessible to all sections of society.

I would like to say that a large proportion of Tamil Nadu is actually funded by the government for liver transplants and that needs to take place throughout the country. If all people who require liver transplant have to be funded, it is going to be a very expensive affair for the governments.

Another challenge is that everybody who needs a liver transplant is not getting it even after funding. Part of the reason is that we rely completely on living donor and we have actually ignored or not done much effort for deceased donors, other than the southern states Tamil Nadu, Kerala and Maharashtra.

Andhra Pradesh has some deceased donor donations and there have been progresses made whereas in the northern or eastern part of India, there are absolutely no cadaver donations. Unless cadaver donations improve, all patients will not have access to liver transplantation.

How do you see the future of liver transplantation in India?

The future of living donor or liver transplantation is going to having a combination of both deceased donor and living donor liver transplant. The numbers in our country are going to increase.

In the next five to ten years the numbers are going to increase fivefold - tenfold and that means we need to train large number of surgeons and many hospitals have to come up offering liver transplantation in a cost effective manner.

The long term future of liver transplantation is when I have to say that we have to manage these patients without the need for liver for liver transplant. There have been several breakthroughs in the treatment of patients with liver disease. Now there are drugs available for hepatitis C.

In most countries hepatitis C liver diseases or hepatitis C cirrhosis forms almost 30 percent for patients who need liver transplant. Now we have got a drug to abolish this hepatitis C completely and cure this disease. Meaning 30 percent of the indications for liver transplants is going to disappear and the necessity for liver transplantation is going to come down.

Now there is also a lot of research on gene therapy which means all metabolic liver diseases which require liver transplant now won’t be needed. Then there are other treatments, artificial liver and liver dialysis work that is being carried out. This hasn’t been so successful till now, but if it does, most of the acute liver failure patients won’t need liver transplants. So that means we are slowly conquering medical treatment of many of the liver diseases and as we conquer medical treatment the requirement for liver transplantation will hopefully come down. Only a small proportion of patients will require transplant and that is the future. So the future is not about developing liver transplant but rather it is about reducing the need for liver transplant.

With immense pride “India Live” celebrated its 10th national conference in Mumbai from 28th February to 3rd March 2019. The conference turned out to be a gold mine of information, with emphasis on academics, education and exchange of knowledge with leaders in interventional cardiology from both India and abroad.